在急诊室快速通道为无需住院的病人提供能力管理人员,缓解拥挤状况。

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Jesper Juul Larsen, Halfdan Lauridsen, Laurits Wullum Gundersen, Birgit Falk Riecke, Thomas A Schmidt
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引用次数: 0

摘要

背景:急诊科(ED)拥挤是患者安全的一大隐患,对医疗系统和医疗服务提供者造成了负面影响。我们假设,通过采用一种多层面的方法来控制拥挤现象是可行的,这种方法包括系统性地快速通道病人,这些病人经初始护士评估后大多不需要住院,并由有决策能力的医生进行治疗:使用 SAP 网络智能工具从电子健康记录数据仓库中提取了 2021 年第 4 季度至 2024 年第 1 季度在二级护理急诊室登记的 120,901 名患者的数据,并使用 Python 编程语言进行了处理。比较了急诊室从单一科室转变为高流量(α)和低流量(β)科室之前和之后的拥挤情况,病人分别被安置在轮床/椅子或病床上。由护士识别出不需要住院治疗的病人,将其安置在α区,并由有决策能力的医生进行评估和治疗。对改变前后拥挤现象的发生率、每天收治病人的数量以及急诊室入院后 72 小时内再次入院的人数进行了测定。数值为患者人数、平均值 ± SEM 和平均差异及 95% CI。统计意义采用学生双尾 t 检验法对非配对值进行检验:ED 变化前后,拥挤度为 130% 的患者分别花费了 123.8 小时和 19.3 小时。差异为 -104.6 ± 23.9 h,95% CI 为 -159.9 至 -49.3,Δ% 为 -84 (p = 0.002)。病人数量相同,分别为 135.8 人/天和 133.5 人/天 Δ% = -1.7 病人 95% CI -6.3 至 1.6 (p = 0.21)。变化前后 72 小时内的再住院率没有变化,分别为 9.0% 和 9.5%,Δ% = 0.5,95% CI -0.007 至 1.0(p > 0.052):结论:通过对不需要住院的患者进行快速评估和治疗,在不增加再次住院率的情况下缓解拥挤状况似乎是可行的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel.

Background: Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by employing a multifaceted approach consisting of systematically fast-tracking patients who are mostly not in need of a hospital stay as assessed by an initial nurse and treated by decision competent physicians.

Methods: Data from 120,901 patients registered in a secondary care ED from the 4tth quarter of 2021 to the 1st quarter of 2024 was drawn from the electronic health record's data warehouse using the SAP Web Intelligence tool and processed in the Python programming language. Crowding was compared before and after ED transformation from a uniform department into a high flow (α) and a low flow (β) section with patient placement in gurneys/chairs or beds, respectively. Patients putatively not in need of hospitalization were identified by nurse, placed in in the α setting and assessed and treated by decision competent physicians. Incidence of crowding, number of patients admitted per day and readmittances within 72 h following ED admission before and after changes were determined. Values are number of patients, mean ± SEM and mean differences with 95% CIs. Statistical significance was ascertained using Student's two tailed t-test for unpaired values.

Results: Before and after ED changes crowding of 130% amounted to 123.8 h and 19.3 h in the latter. This is a difference of -104.6 ± 23.9 h with a 95% CI of -159.9 to -49.3, Δ% -84 (p = 0.002). There was the same amount of patients / day amounting to 135.8 and 133.5 patients / day Δ% = -1.7 patients 95% CI -6.3 to 1.6 (p = 0.21). There was no change in readmittances within 72 h before and after changes amounting to 9.0% versus 9.5%, Δ% = 0.5, 95%, CI -0.007 to 1.0 (p > 0.052).

Conclusion: It appears feasible to abate crowding with unchanged patient admission and without an increase in readmittances by fast-track assessment and treatment of patients who are not in need of hospitalization.

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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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